Diabetes mellitus coronary artery disease

Rosenblatt, S., Miskin, B., Glazer, B. et al. (2001) The impact of pioglitazone on glycemic control and atherogenmic dyslipidemia in patients with type 2 diabetes mellitus. Coronary Artery Disease, 12, 413—423. 

Erectile dysfunction may be the first manifestation of many diseases including diabetes mellitus, coronary artery disease, hyperlipidemia, hypertension, spinal-cord compression, pituitary tumors, and pelvic malignancies. For example, a recent prevalence study found that men with erectile dysfunction were twice as likely to have DM and concluded that erectile dysfunction may be used as an early marker for DM. This relationship was particularly strong in the younger age groups, in vdiich the odds ratio of having DM was 3 (Sun et al. 2006). Two earlier studies found that 11% (Maatman et al. 1987) and 12% (Deutsch and Sherman 1980) of impotent men were found to have previously undiagnosed DM. 

The risk of gout increases as the serum uric acid concentration increases, and approximately 30% of patients with levels greater than 10 mg/dL (greater than 595 pmol/L) develop symptoms of gout within 5 years. However, most patients with hyperuricemia are asymptomatic. Other risk factors for gout include obesity, ethanol use, and dyslipidemia. Gout is seen frequently in patients with type 2 diabetes mellitus and coronary artery disease, but a causal relationship has not been established. 

The formation of atherosclerotic plaques is the underlying cause of coronary artery disease (CAD) and ACS in most patients. Endothelial dysfunction leads to the formation of fatty streaks in the coronary arteries and eventually to atherosclerotic plaques. Factors responsible for development of atherosclerosis include hypertension, age, male gender, tobacco use, diabetes mellitus, obesity, and dyslipidemia. 

Goal BP values are <140/90 for most patients, but <130/80 for patients with diabetes mellitus, significant chronic kidney disease, known coronary artery disease (myocardial infarction [MI], angina), noncoronary atherosclerotic vascular disease (ischemic stroke, transient ischemic attack, peripheral arterial disease [PAD], abdominal aortic aneurysm), or a 10% or greater Framingham 10-year risk of fatal coronary heart disease or nonfatal MI. Patients with LV dysfunction have a BP goal of <120/80 mm Hg. 

Special risk patients Administer with caution to patients with thyroid disease, diabetes mellitus, cardiovascular disease, coronary artery disease, hypertension, peripheral vascular disease, heart disease, ischemic heart disease, increased intraocular pressure, or prostatic hypertrophy. 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Turner, R.C., et al. 1998. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus United Kingdom Prospective Diabetes Study (UKPDS 23). Br Med J 316 823. 

The vasodilator and platelet-regulatory functions of endothelium are impaired during the course of vascular disorders induing atherosclerosis, the coronary artery disease, essential hypertension, diabetes mellitus and preeclampsia (DeBelder and Radomski, 1994), however the pathomechanism of these changes remains unclear. 

A 65-year-old woman with type 2 diabetes mellitus and coronary artery disease received a 0.25 mg/kg bolus of abciximab at the time of intervention followed by an infusion of 10 micrograms/minute for 12 hours. Her baseline platelet counts were 286 x 10 /1 before use, 385 X 10 /1 at 2 hours, and 296 x 10 /1 at 18 hours. On day 7 she developed petechiae over her legs and her platelet count was 1 x 10 /1. Coagulation tests were normal and there was no evidence of heparin-induced thrombocytopenia. She received 10 units of single-donor platelets and recovered slowly over the next 4 days. The platelet count was 114 x 10 /1 on day 12. 

ACS = acute coronary syndrome CAD = coronary artery disease CHD = coronary heart disease DM = diabetes mellitus HTN = hypertension Ml = myocardial Infarction TIMI = Thrombolysis in Myocardial Infarction. 

Sialic acids, which are present in cell membranes and mucous secretions, are thought to allow viruses and other substances to enter cells. Serum sialic acid levels have been shown to increase in certain disease states such as cancers, rheumatic diseases, other inflammatory diseases, and infections (Anonymous, 1993). Elevated serum sialic acid levels have also been found in men with coronary artery disease and type II diabetes mellitus (Pickup et al., 1995). It has been hypothesized that inhibition of the enzyme sialidase, which is involved in the formation of sialic acid, could be of therapeutic importance (Anonymous, 1993). 

Diabetes mellitus is a leading cause of morbidity and mortality mostly because of its vascular complications. Diabetic complications can be broadly classihed into microvas-cular (retinopathy, nephropathy) and macrovascular (coronary artery disease [CAD], cerebrovascular disease, peripheral vascular disease.)... 

In addition to diabetes mellitus, Mr. Applebod has a hyperlipidemia (high blood lipid level—elevated cholesterol and triacylglycerols), another risk factor for cardiovascular disease. A genetic basis for Mr. Applebod s disorder is inferred from a positive family history of hypercholesterolemia and premature coronary artery disease in a brother. 

Free radicals are not just esoteric reactants they are the agents of cell death and destruction. They are involved in all chronic disease states (e.g., coronary artery disease, diabetes mellitus, arthritis, and emphysema) as well as acute injury (e.g., radiation, strokes, myocardial infarction, and spinal cord injury). Through free radical defense mechanisms in our cells, we can often restrict the damage attributed to the "normal" aging process. 

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